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Psychological care in children and adolescents with type 1 diabetes in a real‐world setting and associations with metabolic control
Author(s) -
Galler Angela,
Hilgard Dörte,
Bollow Esther,
Hermann Thomas,
Kretschmer Nicole,
Maier Berthold,
Mönkemöller Kirsten,
Schiel Ralf,
Holl Reinhard W.
Publication year - 2020
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.13065
Subject(s) - medicine , psychosocial , type 1 diabetes , hypoglycemia , diabetic ketoacidosis , diabetes mellitus , pediatrics , type 2 diabetes , metabolic control analysis , ketoacidosis , psychiatry , endocrinology
Background International guidelines recommend psychosocial care for children and adolescents with type 1 diabetes. Objective To assess psychological care in children and adolescents with type 1 diabetes in a real‐world setting and to evaluate associations with metabolic outcome. Methods Delivery of psychological care, HbA1c, and rates of severe hypoglycemia and diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes from 199 diabetes care centers participating in the German diabetes survey (DPV) were analyzed. Results Overall, 12 326 out of 31 861 children with type 1 diabetes were supported by short‐term or continued psychological care (CPC). Children with psychological care had higher HbA1c (8.0% vs 7.7%, P <.001) and higher rates of DKA (0.032 vs 0.021 per patient‐year, P <.001) compared with children without psychological care. In age‐, sex‐, diabetes duration‐, and migratory background‐matched children, HbA1c stayed stable in children supported by CPC during follow‐up (HbA1c 8.5% one year before psychological care started vs 8.4% after two years, P = 1.0), whereas HbA1c was lower but increased significantly by 0.3% in children without psychological care (HbA1c 7.5% vs 7.8% after two years, P <.001). Additional HbA1c‐matching showed that the change in HbA1c during follow‐up was not different between the groups, but the percentage of children with severe hypoglycemia decreased from 16.3% to 10.7% in children receiving CPC compared with children without psychological care (5.5% to 5.8%, P =.009). Conclusions In this real‐world setting, psychological care was provided to children with higher HbA1c levels. CPC was associated with stable glycemic control and less frequent severe hypoglycemia during follow‐up.